<p> BLACK MOUNTAINS GLIDING CLUB FULL & COUNTRY MEMBERSHIP FORM Membership year starting 1st March 20 </p><p>PLEASE COMPLETE FORM USING BLOCK CAPITALS ACCOUNT CODE if known </p><p>Your Details Next of Kin Details Name: Name: D of B: Contact No(s): Tel No(s): Relationship: E-Mail: Address: (if different) Address:</p><p>Flying Details:</p><p>Flying in last Total Launches Hours X-C km Launches Hours 12 months: Flying:</p><p>Flying Pre Solo Solo BI Ass Cat Full Cat Experience:</p><p>Badges held: Official Observer number: (if relevant)</p><p>Membership: Joint members please complete a form each with payment details on just one. Associate members please complete Associate’s form.</p><p>Full Membership Joint Full Life £</p><p>Country Membership Joint Country Home Club: £</p><p>Student Membership (under 18 or under 25 and in full time education) £</p><p>Associate Membership Associate member name: £</p><p>Glider Trailer Parking Glider ID(s): £</p><p>Total Amount Due £</p><p>I do not suffer from any medical condition that might cause difficulty whilst flying. My current medical declaration is held by BMGC OR I attach my current medical declaration </p><p>I understand that I am unable to fly P1 in a club glider unless the club holds a copy of my current medical declaration. I apply to join/renew my membership and declare that I will abide by the club rules & codes of practice as published. I will also comply with the Child Protection Policy as displayed in the clubhouse.</p><p>Signed: Date:</p><p>Please return to the Membership Secretary, Black Mountains Gliding Club, The Airfield, Talgarth, Brecon. LD3 0EJ</p><p>Black Mountains Gliding Club is a company limited by guarantee, registered in England and Wales. Registered number 03194847 Registered office: The Airfield, Talgarth, Brecon, LD3 0EJ</p>